Permit (102) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00073
Tf(-3 A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/01/2017
Parcel: 2S112DD00500
Jurisdiction: Tigard
Site address: 15860 SW UPPER BOONES FERRY RD B15
Project: Air Reps Subdivision: None
Project Description: (1)branch circuit and(1)HVAC low voltage system for RTU. Lot: None
Contractor: ENVIRONMENTAL CONTROLS CORP Owner: PACIFIC REALTY ASSOCIATES LP
15954 SW 72ND AVE 15350 SW SEQUOIA PKWY, SUITE 300
TIGARD, OR 97224 PORTLAND, OR 97224
PHONE: 503-544-9819 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 crt Branch Circuits wo/Purchase 02/01/2017 $56.18
Service or Feeder
1 ea 12%State Surcharge- 02/01/2017 $15.74
Type of Use: COM Electrical
Class of Work: ALT 1 ea Limited Energy 02/01/2017 $75.00
Type of Const:
Occupancy Grp:
Total $146.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR, Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issua I 's suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica'.n Ce _ . Thos- r.les are set forth in 0 R
952-001-0010 through OAR 952-001-0090. You nav obtain a of the rules or direct questions to OUNC by calling '3.232. i or 1.:r' 344.
r
Issued By: ,.���v� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE
Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'
Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
FO12 0HICt: l Sl:0V'l,l
City of Tigard Received
u 13125 SW Hall Blvd.,Tigard,OR 97223 ,,`"1.'1 Date/B : / 7 L Permit#: r,7_ 7'
C Phone: 503.718.2439 Fax: 503.598 196,0:. '-a-- }x'4�� Plan Review
Inspection Line: 503.639.4175 1♦ Date/B : Related Permit#:
T I G A R D , Ready Date/By: i ]v7
Internet: www.tigard-or.gov '''' ( Supplemental See Page 2 for
C c`�� 9 ��f Notified/Method: Information
TYPE OF WORK F�V 1 n,�
❑New construction ry` _ PLAN REVIEW
Addition/alteration/r e
k �aCienY 1 Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: -, -:.''A''',.%°,-,:-:'` ❑Service or feeder 400 amps or more
P 0 Building over three stories.
CATEGORY OF CONS where the available fault current 0 Marinas and boatyards.
lON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 'KCommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other:
JOB SITE INFORMATION AND LOCATION 0 Fire pump. ❑Installation of 150 KVA or
0 Emergency system. larger
separately derived
Job#: I •JOb site address: `J•••,. .• I U r' 0 Addition of new motor load of system.
W' f! 30f�,,,e‘ way 100HP or more. 0`•A» ••E» ••1-2» `<1-3„
City/State/ZIP: to I 1 035 --Li 04 C, ❑Six or more residential units. occupancy.
Suite/bld /a t.#: �� I ` ❑Health-care facilities. 0 Recreational vehicle parks.
g• II Project name: /1-r D p�-s e - 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: /' .l-fes T-ii ❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description 1 Qty. f Each f Total I *
Subdivision: New residential single-or multi-family dwelling unit.
I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 33.92 1
`� j / Limited energy,residential
`tom+ �,$ZA_ICIf CSR (.J -1 [ tE-G (,o..“.►e(dr 5a e / 'so 4 (with above sq.ft.) 75.00 2
-�'- --4.7Limited energy,multi-family
LA residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER I IX TENANT
Name: A I.e.- 7 Services or feeders installation,alteration,and/or relocation
pc
�'� ! 200 amps or less 100.70 2
Address: kS t�60 5� r l V gat. S�__Q�,� 201 amps to 400 amps
Vt? gat. xj k'l,- I .� p 133.56 2
City/State/ZIP: `ri ESP O 2- 91 Das--_ y Ob�1 401 amps to 600 amps 200.34 2
I �1 601 amps to 1,000 amps 301.04 2
Phone:(5'0 ) 1:,2,0 -y3 0 v Fax:
( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is beingmade onpropertysrelocation
intended for sale,lease,rent,or exchange,acording to ORS ,449,670,and 701. 201
2001 amps toor l00ess 59.365 1
201 amps to 400 amps ]25.08 2
Owner signature: Date: 401 amps to 599 amps
168.54 2
V1 APPLICANT 1 0 CONTACT PERSON Branch circuits-new,alteration,or extension,eer panel
Business name: fir„t y 1 2.Py Mo- �,L Co��`$, (9,7 A.above
sbrvnch or feei a fee,
above service feeder fee,
Contact name: �Y &Z.) A(7.-T-0
,= each branch circuit 7.42 2
B.Fee for branch circuits without
Address: '54\Sy !]‘id '��� AA/ service or feeder fee,first r
branch circuit f 56.18 ��,� 2
City/State/ZIP: --�,�A0_ OIL. 912_2-'1 Each add'l branch circuit
7.42 2
Phone:(5p?) ) 11.11-1 -Q�3 I Fax::( ) Miscellaneous(service or feeder not included)
i;(..1--?t)
Each manufactured or modular
Email: 3 f O Tr Li L(--?oQ.T i - _ .. dwelling,service and/or feeder 67.84 2
CONTRACT-OR Reconnect only 67.84 2
Business name: Roy, _ Pump or irrigation circle 67.84
//' / 2
q 7,0,_A t"`'�1j-/-*,L"- ( ,p�,{1'rW t S (10 A-� Sign or outline lighting 67.84 2
Address: �� )S l.I --1p A `� Signal circuit(s)or limited-energy
l f!*� panel,alteration,or extension
0 See Page 2 Z�.Ov 2
City/State/ZIP:---c-;
P� O q-•7 2.-7.--'1Each additional inspection over allowable in any of the above
Phone:(61)3) 6.2,0 - 4 7-2-v Additional inspection(1 hr min) 66.25/hr
I Fax:( ) Investigation(1 hr min)
90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
CCB LiC.:2-0(2-0
(7 Inspections for which no fee is
f) I Electrical Lic.: I Suprv.Lic.: ki O+I S specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: ; ELECTRICAL PERMIT FEES
(���r' Subtotal: 1$ (.1 v
Print name: ��
Lt��12�.S I Date: �_. '�:4„0/7 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1 5.']4
Authorized signature:
TOTAL PERMIT FEE: I f(. Gi 7,
I Print name: This permit application expires if a permit is not obtained within 180
II Date: days after it has been accepted as complete.
I:\Builth❑g\Pe„n;ts\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 * Number of inspections allowed per permit.
440-4615 T(l 1/05/COM/W EB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE SCHEDULE
RESIDENTIAL WORK ONLY: Description IQty. I Each I Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 100.70 2
5 kva or less
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
0
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva 301.04 2
LI
50.01 to 100 kva 552.26 2
Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
0 Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El >100 kva-no additional charge 0.0 3
Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL
WORKONLY:; Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
Boiler Controls
0 Clock Systems
0 Data Telecommunication Installation
El Fire Alarm Installation
IR(HVAC
[] Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
0 Medical
O Nurse Calls
O Outdoor Landscape Lighting*
0 Protective Signaling
O Other:
Total number of commercial systems: —
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015